AB0729 EVALUATION OF DIFFERENT TREATMENT REGIMENS IN TAKAYASU’S ARTERITIS: A SINGLE CENTER STUDY
Authors: M. Codirenzi, L. Iorio, F. Davanzo, R. Padoan, A. Doria
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Takayasu's arteritis (TAK) is a large-vessel vasculitis associated with high morbidity and mortality. Although new biological immunosuppressive drugs have been introduced in recent years, there is no strong evidence on which therapy is most effective to obtain a faster and lasting remission. <h3>Objectives</h3> The aim of the present study is to evaluate how different treatment approaches could provide better results in terms of disease activity, imaging improvement, glucocorticoids (GC) sparing and damage progression. <h3>Methods</h3> Inpatients and outpatients, classified as TAK, referred to our third level rare diseases center, were retrospectively assessed. We included all patients with complete clinical data and that underwent at least three consecutive visits. Patients were subdivided and compared according to five different treatment approaches: GC monotherapy, conventional disease modifying antirheumatic drugs (cDMARDs) monotherapy, anti-tumor necrosis factor (anti-TNF) monotherapy, combination therapy with cDMARDs+anti-TNF and Tocilizumab (TCZ). Demographic, clinical and laboratory data were collected. Imaging features (PET scan, magnetic resonance angiography, CT angiography, ultrasonography) were evaluated and registered. Clinical activity was assessed using the Indian Takayasu Clinical Activity Score (ITAS2010) (1) while damage according to the Large-Vessel Vasculititis Index of Damage (LVVID) [2]. <h3>Results</h3> The study included 31 TAK patients (age 28 [21-48], 87% female) exposed to a total of 52 treatment regimens (n=4 GC monotherapy, n=17 cDMARDs, n=5 anti TNF, n=20 cDMARDs+antiTNF, n=6 TCZ). Overall clinical remission rate during the follow-up was 75% in GC treated patients, 70.6% in cDMARDs-treated, 100% in anti-TNF-treated, 80% in cDMARDs+anti-TNF-treated and 100% in TCZ-treated. Persistence of treatment was 19[8-30.75] months in GC group, 10[5.5-26.5] in cDMARDs group, 15[12-44] in anti-TNF group, 21[12.75-81.75] in cDMARDs+antiTNF group and 4 [17-64.5] in TCZ group. Treatment with cDMARDs+antiTNF and TCZ led to significant reduction of acute phase reactants (C-Reactive Protein: cDMARDs+antiTNF 31[9.1-93]vs2.9[0.4-16] mg/L, &lt;0.001; TCZ 31.5[10.5-59]vs2.9[0.2-8.75] mg/L, 0.009) (Erythrocyte Sedimentation Rate: cDMARDs+antiTNF 43[14-84]vs17.5[10-25.75] mmh, 0.017; TCZ 15[5-55]vs5.5 [2-11.75]). Daily GC dose at last follow-up was 0 in cDMARDs+antiTNF group (25vs0 mg, p&lt;0.001) and TCZ (11.25vs 0 mg, p&lt;0.007). All the therapeutic regimens led to a significant reduction of disease activity at last follow-up (ITAS2010 in GC-treated 0 [0-1.5], in cDMARDs-treated 0 [0-1], in anti-TNF treated 0 [0-1], in cDMARDs+antiTNF 0 [0-0], in TCZ 0 [0-0]). LVVID did not significantly increase during follow-up in patients treated with cDMARDs, anti-TNF, cDMARDs+anti-TNF and in TCZ. Imaging data shown an improvement in metabolic activity at LFU in 33.3% of TCZ-treated patientsp and in 40% of cDMARDs+anti-TNF treated patients. <h3>Conclusion</h3> Anti-TNF, cDMARDs+anti-TNF and TCZ led to a statistically significant reduction in GC dosage, allowing steroid sparing. Compared to monotherapy, treatment regimens with cDMARDs+anti-TNF and TCZ could lead to a better disease control in terms of clinical activity and inflammatory markers and overall is the only therapeutic lines that provides an improvement in metabolic activity on imaging. <h3>References</h3> [1]Ramnath Misra et al., Development and initial validation of the Indian Takayasu Clinical Activity Score (ITAS2010), <i>Rheumatology</i>, Volume 52, Issue 10, October 2013. [2]Kermani TA et al., Evaluation of damage in giant cell arteritis. Rheumatology (Oxford). 2018 Feb 1. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.